A Randomised Clinical Trial Comparing Topical Itraconazole 1% With Topical Natamycin 5% for the Treatment of Filamentous Fungal Keratitis

Aim: To compare the clinical efcacy of itraconazole 1% eyedrops with natamycin 5% eyedrops for topical monotherapy of lamentous fungal keratitis. Patients presenting with features suggestive of fungal Methods: keratitis over a period of 24 months from January2022 to December 2023 underwent detailed clinical examination and microbiological investigation. Eighty three eyes of eighty three patients with direct smear and/or culture-proven fungal keratitis were enrolled in the study after obtaining informed consent. Forty three patients received primary therapy with topical natamycin hourly labelled as group 1,and forty patients received topical itraconazole hourly labelled as group 2. Success of the treatment was dened as a healed or healing ulcer at nal visit, and failure as an ulcer that worsened or remained same at nal visit. On the basis of direct microscopy and culture t Results: he most common fungal isolate found is Fusarium in 43 cases (51.8%) followed by Aspergillus in 17 cases (20.4%). In thirty-one (72%) of 43 patients in group 1 and 24 (60%) of 40 patients in group 2, the ulcer resolved completely. In keratitis due to Fusarium spp, 18 (79%) of 23 patients showed a favorable response to natamycin, whereas 8 (44%) of 20 patients showed a favorable response to itraconazole. However, no such difference was evident in keratitis due to Aspergillus spp or Curvularia spp. Both antifungal formulations were generally well tolerated with no obvious adverse effects. Conclusions: Topical 5% natamycin appears to be safe and effective therapy for the management of fungal keratitis and should be considered as the treatment of choice for lamentous fungal keratitis, especially in cases affected with Fusarium spp. Topical itraconazole therapy could be considered , particularly if the infections are due to Aspergillus or Curvularia spp.